Topic Contents

Shoulder Replacement Surgery

Surgery Overview

Joint replacement involves surgery to replace
the ends of bones in a damaged joint. This surgery creates new joint
surfaces.

In shoulder replacement surgery, doctors replace the
ends of the damaged upper arm bone (humerus) and usually the shoulder bone
(scapula) or cap them with artificial surfaces lined with plastic or metal and
plastic. Shoulder joint components may be held in place with
cement. Or they may be made with material that allows
new bone to grow into the joint component over time to hold it in place without
cement.

The top end of your upper arm bone is shaped like a ball.
Muscles and ligaments hold this ball against a cup-shaped part of the shoulder
bone. Surgeons usually replace the top of the upper arm bone with a long metal
piece, inserted into your upper arm bone, that has a rounded head. If the
cup-shaped surface of your shoulder bone that cradles your upper arm bone is
also damaged, doctors smooth it and then cap it with a plastic or metal and
plastic piece.

Surgeons are now trying a newer procedure called a
reverse total shoulder replacement for people who have painful arthritis in
their shoulder and also have damage to the muscles around the shoulder. In this
procedure, after the surgeon removes the damaged bone and smooths the ends, he
or she attaches the rounded joint piece to the shoulder bone and uses the
cup-shaped piece to replace the top of the upper arm bone. Early results are
encouraging.footnote 1 This surgery is not right for everyone. And not all surgeons have done it. Success depends not only on careful evaluation to be sure it's the right surgery for you but also on having a surgeon with experience in reverse shoulder replacement.footnote 2

Doctors often use general
anesthesia for joint replacement surgeries. This
means you'll be unconscious during surgery. But sometimes they use regional
anesthesia, which means you can't feel the area of the surgery and you are
sleepy, but you are awake. The choice of anesthesia depends on your doctor, on
your overall health, and, to some degree, on what you prefer.

Your
doctor may recommend that you take antibiotics before and after the surgery to
reduce the risk of infection. If you need any major dental work, your doctor
may recommend that you have it done before the surgery. Infections can spread
from other parts of the body, such as the mouth, to the artificial joint and
cause a serious problem.

What To Expect After Surgery

Right after surgery

You will have intravenous (IV)
antibiotics for about a day after surgery. You will also receive medicines to
control pain and perhaps medicines to prevent blood clots. It
is not unusual to have an upset stomach or feel constipated after surgery. Talk
with your doctor or nurse if you don't feel well.

When you wake up
from surgery, you will have a bandage on your shoulder and probably a drain to
collect fluid and keep it from building up around your joint. You may have a
catheter, which is a small tube connected to your
bladder, so you don't have to get out of bed to urinate. You may also have a
compression sleeve on your arm. This sleeve squeezes your arm to keep the blood
circulating and to help prevent blood clots.

A physical therapist
may begin gentle exercises of your shoulder on the day of surgery or the day
after. These exercises are just passive motion, which means you relax and let
the therapist move your arm for you.

Most people who have shoulder
replacement surgery are able to sit up and get out of bed with some help later
on the day of surgery.

Your doctor may teach you to do simple
breathing exercises to help prevent congestion in your lungs while your
activity level is reduced.

The first few days

You will probably still be
taking some medicine. You will gradually take less and less pain medicine. You
may continue taking medicines to prevent blood clots for several weeks after surgery.

A physical therapist will move your arm for you to keep your shoulder
loose as it heals. The therapist will also show you how to use a pulley device
so you can move your arm when you go home from the hospital. Your therapist may
also begin some simple exercises to keep the muscles of your other arm and your
legs strong.

Rehabilitation (rehab) after a shoulder replacement
starts right away. It is not too demanding early on, but it is very important
that you do it. Most doctors will not allow you to use the shoulder muscles for
several weeks after surgery. The main goal of rehab is to allow you to move
your shoulder as far as possible so it's easier for you to do daily activities,
such as dressing, cooking, and driving. Most people eventually regain about
two-thirds of normal shoulder motion after surgery. But other things that
affect how much movement you get back after surgery are how much movement you had
before surgery and whether the soft tissues around your shoulder were also
damaged. It is very important that you take part in physical therapy both while
you are in the hospital and after you are released from the hospital to get the
most benefit from your surgery.

Most people go home 1 to 3 days
after surgery. Some people who need more extensive rehab or those who don't
have someone who can help at home go to a specialized rehab center for more
treatment.

Continued recovery

After you go home, watch the
surgery site and your general health. If you notice any redness or drainage
from the wound, tell your surgeon. You may also be advised to take your
temperature twice each day and to let your surgeon know if you have a fever
over 100.5°F (38.1°C).

You will have an exercise program to follow when you go home, even if you
are still having physical therapy. You should use the pulley to move your arm 4
to 5 times each day. If you notice any soreness, try a
cold pack on your shoulder and perhaps reduce your activity a bit, but
don't stop completely. Staying on your exercise program will help speed your
recovery.

Rehab typically continues after you leave the hospital
until you are able to function more independently and you have recovered as
much strength, endurance, and mobility in your shoulder as you can. Total rehab
after surgery will take several months.

6 weeks of very limited activity. No movement
of the shoulder using the shoulder muscles is permitted. You will use the
pulley to help lift your arm and keep your shoulder flexible. Your physical
therapist may also show a family member how to do some other exercises for you,
such as rotating your arm to the outside and elevating your shoulder. You will
have a sling to wear at night. And it's a good idea to also put a small stack
of folded sheets or towels under your upper arm while you are in bed to keep
your arm from dropping too far back. Your arm should stay next to your body or
in front of it for several weeks, both while you are up and during sleep. Don't
lift anything heavier than a cup of coffee during this
time.

Exercises and stretching, starting 6 weeks after surgery.
This stage usually lasts until 3 months after surgery and includes active use
of the shoulder muscles to do exercises. The therapist will also begin more
vigorous stretching of the soft tissues around the shoulder.

More
intensive strength training starting 3 months after surgery.

Living with a shoulder replacement

Your doctor may
want to see you from time to time for several months or more to monitor your
shoulder replacement. Over time, you will return to many of your presurgery
activities.

For at least 2 years after your surgery, your doctor
may want you to take antibiotics before dental work or any invasive medical
procedure. This is to help prevent infection around your shoulder replacement.
After 2 years, your doctor and dentist will decide whether you still need to
take antibiotics. Your general health and the state of your other health
conditions will help them decide.

Why It Is Done

Doctors recommend joint replacement
surgery when shoulder pain and loss of function become severe and when
medicines and other treatments no longer relieve pain. Your doctor will use
X-rays to look at the bones and cartilage in your shoulder to see whether they
are damaged and to make sure that the pain isn't coming from somewhere else.

Shoulder replacement may not be recommended for people
who:

Have poor general health and may not tolerate
anesthesia and surgery well.

Some doctors will recommend other types of surgery if
possible for younger people and especially for those who do strenuous work. A
younger or more active person is more likely than an older or less active
person to have an artificial shoulder joint wear out.

Doctors
usually do not recommend shoulder replacement surgery for people who have very
high expectations for how much they will be able to do with the artificial
joint (for example, people who expect to be able to play competitive tennis,
paint ceilings, or do other activities that stress the shoulder joint). The
artificial shoulder allows a person to do ordinary daily activities with less
pain. It does not restore the same level of function that the person had before
the damage to the shoulder joint began.

How Well It Works

Most people have much less pain
after shoulder replacement surgery and are able to do many of their daily
activities more easily.

The shoulder will not move as far as it did
before you started having shoulder problems. But the surgery will allow you to
do more of your normal activities without pain.

After surgery, you
may be allowed to resume activities such as golfing, riding a bike, swimming,
walking for exercise, dancing, or cross-country skiing (if you did these
activities before).

Your doctor may discourage you from doing
things that put a lot of stress on the joint.

The younger you are when you have the surgery, and the more
stress you put on the joint, the more likely it is that you will eventually
need a second surgery to replace the first artificial joint. Over time, the
components wear down or may loosen and need to be replaced.

Your
artificial joint should last longer if you do not do hard physical work or play
sports that stress the joint. If you are older than 60 when you have joint
replacement surgery, the artificial joint will probably last the rest of your
life.

Risks

The risks of shoulder replacement surgery
include:

Blood clots. People can develop a blood clot in a
leg vein after shoulder joint replacement surgery but usually only if they are
inactive. Blood clots can be dangerous if they block blood flow from the leg
back to the heart or move to the lungs. Blood clots occur more commonly in
older people, people who are very overweight, people who have had blood clots
before, and those who have cancer.

Infection in the surgical wound or in the joint. Infection is rare in people who are otherwise healthy.
People who have other health problems, such as diabetes, rheumatoid arthritis,
or chronic liver disease, or those who are taking corticosteroids are at higher
risk of infection after any surgery. Infections in the wound usually are
treated with antibiotics. Infections deep in the joint may require more
surgery. And in some cases the artificial joint must be removed.

Nerve injury. In rare cases, a nerve may be injured
around the site of the surgery. It is more common (but still unusual) if the
surgeon is also correcting deformities in the joint. A nerve injury may cause
tingling, numbness, or difficulty moving a muscle. These injuries usually get
better over time and in some cases may go away completely.

Problems with wound healing. Wound healing problems
are more common in people who take corticosteroids or who have diseases that
affect the immune system, such as rheumatoid arthritis and diabetes.

Lack of good range of motion. How far you can move
your shoulder after surgery depends a lot on how far you could move your
shoulder before surgery. Some people are not able to move their shoulder far
enough to allow them to do their regular daily activities, even after several
weeks of recovery. If this happens, the doctor may give you a medicine to relax
your muscles and will gently force the shoulder to move farther. This may
loosen tissues around the joint that are preventing you from bending it.

Dislocation of the upper arm bone (humerus). This
usually only happens if the soft tissues around the shoulder are stretched too
soon after surgery. To help prevent dislocation, do not allow your elbow to
move past your body toward your back.

Fracture of the upper arm bone. This is an unusual
complication, but it may happen either during or after surgery.

Instability in the joint. This can be the result of
either the soft tissues being stretched too soon after surgery, or the new
joint pieces loosening.

The usual
risks of general anesthesia. Risks of any surgery
are higher in people who have had a recent heart attack and those who have
long-term (chronic) lung, liver, kidney, or heart disease.

What To Think About

Continued exercise is important
for your general well-being and muscle strength. Discuss with your doctor what
type of exercise is best for you.

You may donate your own blood to
use during surgery if needed. This is called autologous blood donation. If you
choose to do this, start the donation several weeks before the surgery so that
you have time to donate enough blood and rebuild your blood volume before
surgery.

If you need more than one joint replacement surgery, such
as a shoulder and a hip or a shoulder and an elbow, it can be hard to decide which surgery to have first. You and your doctor can discuss the best plan for you.

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